Neonatal aortic stenosis is a complex condition requiring early intervention, with outcomes improving due to better patient selection, perioperative management, and advances in catheter technology.
Management of neonatal aortic stenosis is evolving, with improved outcomes for biventricular approaches and emerging techniques such as fetal intervention and 3D echocardiography.
Neonatal aortic stenosis is a complex and heterogeneous condition, defined as left ventricular outflow tract obstruction at valvular level, presenting and often requiring treatment in the first month of life. Initial presentation may be catastrophic, necessitating hemodynamic, respiratory and metabolic resuscitation. Subsequent management is focused on maintaining systemic blood flow, either via a univentricular Norwood palliation or a biventricular route, in which the effective aortic valve area is increased by balloon dilation or surgical valvotomy. In infants with aortic annular hypoplasia but adequately sized left ventricle, the Ross-Konno procedure is also an attractive option. Outcomes after biventricular management have improved in recent years as a consequence of better patient selection, perioperative management and advances in catheter technology. Exciting new developments are likely to significantly modify the natural history of this disorder, including fetal intervention for the salvage of the hypoplastic left ventricle; 3D echocardiography providing better definition of valve morphology and aiding patient selection for a surgical or catheter-based intervention; and new transcutaneous approaches, such as duel beam echo, to perforate the valve.
Drury et al. (Thu,) conducted a review in Neonatal aortic stenosis. Neonatal aortic stenosis is a complex condition requiring early intervention, with outcomes improving due to better patient selection, perioperative management, and advances in catheter technology.